May 8, 2014
Collaboration Between Psychologists and Physicians Important to Improving Primary Health Care
Such partnering would improve diagnosis and access; two known barriers to better primary care outcomes
WASHINGTON — Primary care teams that include both psychologists and physicians would help address known barriers to improved primary health care, including missed diagnoses, a lack of attention to behavioral factors and limited patient access to needed care, according to health care experts writing in a special issue of American Psychologist®, the flagship journal of the American Psychological Association.
“At the heart of the new primary care team is a partnership between a primary care clinician and a psychologist or other mental health professional. The team works together to produce a comprehensive, integrated personal care plan for each patient that includes attention to mental and medical disorders, addresses substance abuse issues and incorporates health behavior change,” wrote Susan H. McDaniel, PhD, of the University of Rochester Medical Center, and Frank V. deGruy III, MD, of the University of Colorado Denver School of Medicine, in An Introduction to Primary Care and Psychology (PDF, 102KB).
The special issue has 11 articles, co-authored by psychologists and primary care physicians, covering areas including pediatrics, obstetrics and gynecology, palliative care, military service members’ and veterans’ health services, and care for special needs groups such as people with serious mental illness, refugees and deaf people.
“Improving our national health care system requires strengthening primary care, which covers a large majority of health care needs for individuals and families,’’ said Norman B. Anderson, PhD, APA chief executive officer and American Psychologist editor. “Research clearly shows that psychological, behavioral and social factors are key drivers of health problems seen in the primary care settings. This special issue highlights some opportunities, challenges and successes in incorporating psychology into collaborative integrated health care to achieve truly comprehensive, whole-person primary care.”
“The majority of people in the United States receive care for mental disorders, substance use disorders and health behavior problems in the primary care setting,” wrote McDaniel and deGruy, who served as the issue’s scholarly leads. “Yet primary care professionals have up to this point been poorly equipped to address these behavioral concerns adequately — they diagnose less than one-third of patients so afflicted and provide acceptable treatment for less than half of those correctly identified.”
A 2009 survey of 6,600 primary care physicians found that two-thirds could not gain access to mental health services for their patients, often because of shortages of behavioral health care providers. “Even where these relationships exist, there have been systemic barriers to sustaining collaboration, such as health insurance obstacles and lack of health care coverage,” wrote authors Benjamin F. Miller, PsyD, and Larry A. Green, MD, both of the University of Colorado Denver School of Medicine.
“Pediatric primary care settings provide the most accessible and least stigmatizing resource for many families who have concerns about their children’s development and/or behavior,” wrote co-authors Terry Stancin, PhD, of MetroHealth Medical Center, Cleveland, and Case Western Reserve University, and Ellen C. Perrin, MD, of the Floating Hospital for Children and Tufts Medical Center, Boston. Up to 66 percent of families referred for on-site counseling follow through with mental health referrals, compared with less than 5 percent of families referred for off-site counseling, research has found. Pediatric psychologists can address complex family issues and help foster skills to cope with treatment. Psychology interventions that have helped children suffering from asthma can be adapted for many other conditions, such as diabetes, seizures, cancer, sickle cell anemia, Crohn’s disease and migraine headaches, according to the article.
Co-authors Ellen L. Poleshuck, PhD, and James Woods, MD, both of the University of Rochester Medical Center, explain how common physical health issues among women, such as problems with menstruation, pregnancy and menopause, are closely linked with behavioral health. Women are nearly four times more likely to follow up with behavioral health treatment when services are offered at the same site, according to the research.
Applying the Inter-professional Patient Aligned Care Team in the Department of Veterans Affairs: Transforming Primary Care and Tipping Points in the Department of Defense’s Experience with Psychologists in Primary Care (PDF, 214KB)
Lead authors Christopher L. Hunter, PhD, of the Defense Health Agency, and Lisa K. Kearney, PhD, of the Veterans Health Administration, Department of Veterans Affairs, and University of Texas, provide examples of successful collaborative integrated care programs for service members and veterans. The Department of Defense and Veterans’ Affairs “have developed some of the most advanced integrated primary care solutions in existence, with the particular health care needs of soldiers and veterans in mind. Psychologists are deeply integrated into leadership position in their primary care systems,” wrote McDaniel and DeGruy.
Contact: Christopher Hunter or Lisa Kearney
Other articles include
Opportunities for Psychologists in Palliative Care: Working With Patients and Families Across the Disease Continuum (PDF, 154KB), by Julia E. Kasl-Godley, PhD, VA Palo Alto Health Care System; Deborah A. King, PhD, of the University of Rochester Medical Center and VA Center of Excellence for Suicide Prevention; and Timothy E. Quill, MD, of the University of Rochester.
Integrating Primary Care and Behavioral Health With Four Special Populations: Children With Special Needs, People With Serious Mental Illness, Refugees, and Deaf People (PDF, 102KB), by Robert Q. Pollard Jr., PhD, Jennifer K. Carroll, MD, and Steven Barnett, MD, of the University of Rochester; Jeanette A. Waxmonsky, PhD, William R. Betts, PhD, Frank V. deGruy, MD, Laura L. Pickler, MD, and Yvonne Kellar-Guenther, PhD, of the University of Colorado Denver School of Medicine.
Robert Pollard Jr.
New Collaborations for Providing Effective Care for Adults With Chronic Health Conditions (PDF, 93KB), by Lawrence Fisher, PhD, of the University of California, San Francisco, and Perry W. Dickinson, MD, of the University of Colorado Health Sciences Center.
Research and Evaluation in the Transformation of Primary Care (PDF, 130KB), by C.J. Peek, PhD, University of Minnesota; Deborah J. Cohen, PhD, Oregon Health & Science University, and Frank V. deGruy III, MD, University of Colorado Denver School of Medicine.
Competencies for Psychology Practice in Primary Care (PDF, 138KB), by Susan H. McDaniel, PhD, of the University of Rochester Medical Center; Catherine L Grus, PhD, APA Education Directorate; Barbara Cubic, PhD, Eastern Virginia Medical School; Christopher Hunter, PhD, Defense Health Agency; Lisa K. Kearney, PhD, of the Veterans Health Administration, Department of Veterans Affairs, and University of Texas; Catherine Schuman, PhD; Harvard Medical School; Michel J. Karel, PhD, Department of Veterans Affairs; Rodger S. Kessler, PhD, Vermont College of Medicine; Kevin Larkin, PhD, West Virginia University; Stephen McCutcheon, PhD, VA Puget Sound Health Care system; Benjamin F. Miller, PsyD, University of Colorado Denver School of Medicine; Justin Nash, PhD, Brown University and Memorial Hospital of Rhode Island; Sara Qualls, PhD, University of Colorado; Kathryn Sanders, PhD, VA Connecticut Healthcare System and Yale University School of Medicine; Terry Stancin, PhD, MetroHealth Medical Center, Cleveland, and Case Western Reserve University; Annette L. Stanton, PhD, University of California, Los Angeles; Lynne Sturm, PhD, Indiana University School of Medicine; Suzanne Bennett Johnson, PhD, Florida State University College of Medicine.
Susan H. McDaniel
Copies of articles are available from APA Public Affairs, (202) 336-5700.
Special Issue: Primary Care and Psychology, American Psychologist, May 2014
Susan H. McDaniel can be contacted by email.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 130,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.